NPIMap

Organization Active NPI

Utah State Developmental Center

  • Mental Illness Intermediate Care Facility
  • American Fork, UT
National Provider Identifier
1689674301
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Intermediate Care FacilityTaxonomy code 310500000X
License
2004-NCF-95 Issued in UT
Legal business name
UTAH STATE DEVELOPMENTAL CENTER
Practice address
895 N. 900 E.
American Fork, UT 84003-9199
Phone
(801) 763-4000
Fax
(801) 763-4073
NPI assigned
Jul 22, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Karen Clarke
Title
Superintendent
Phone
(801) 763-4091

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Intermediate Care Facility 310500000X 2004-NCF-95 UT Primary

Addresses

Primary practice location

895 N. 900 E.
American Fork, UT 84003-9199

Mailing address

895 N. 900 E.
American Fork, UT 84003-9199
Phone (801) 763-4000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040117000195 UT Part B Supplier - Clinic/Group Practice 6800797333 Receives reassigned benefits from 86 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: American Fork, UT; Ogden, UT; Provo, UT; Salt Lake City, UT

Intermediate care facility for individuals with intellectual disabilities certification: CCN 46G009

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
UTAH STATE DEVELOPMENTAL CENTER
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Jul 1, 1977
Last certification
Apr 17, 2025
Beds
260
Ownership / control type
State
Facility address
895 North 900 East
American Fork, UT 84003

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
San Juan Counseling Ctr28 organizations share this tax ID, including this one

Other organizations with this tax ID 27

Organizations that report the same tax identification number in the National Provider Directory.

View all 27

Locations

895 N 900 E
American Fork, UT 84003
Phone (801) 756-6022

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1121990400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1689674301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "895 N. 900 E.",
            "city": "AMERICAN FORK",
            "state": "UT",
            "postal_code": "840039199",
            "telephone_number": "801-763-4000",
            "fax_number": "801-763-4073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "895 N. 900 E.",
            "city": "AMERICAN FORK",
            "state": "UT",
            "postal_code": "840039199",
            "telephone_number": "801-763-4000",
            "fax_number": "801-763-4073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UTAH STATE DEVELOPMENTAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CLARKE",
        "authorized_official_first_name": "KAREN",
        "authorized_official_title_or_position": "SUPERINTENDENT",
        "authorized_official_telephone_number": "801-763-4091"
    },
    "taxonomies": [
        {
            "code": "310500000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Mental Illness",
            "state": "UT",
            "license": "2004-NCF-95",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in American Fork, UT

Sources for this page

Verify at the official NPI Registry.